Detecting Donor-Derived DNA by Real-Time PCR in Recipients Suspected of Graft-Versus-Host-Diseases After Liver Transplantation: A Case Series and Literature Review.

IF 1.1 4区 医学 Q3 SURGERY
Changhee Ha, Sang Jin Kim, Jong Man Kim, Jae-Won Joh, Kee-Taek Jang, Gyu-Seong Choi, Eun-Suk Kang
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引用次数: 1

Abstract

BACKGROUND Graft-versus-host disease (GVHD) after liver transplantation (LT) is a rare but fatal complication. GVHD diagnosis is usually based on clinical symptoms and pathologic confirmation. However, it is often misdiagnosed due to its non-specific symptoms. Here, we report the detection of donor-cell chimerism using peripheral blood (PB) donor-derived deoxyribonucleic acid (ddDNA) for 3 cases with suspected GVHD after LT (GVHD-LT) through real-time quantitative polymerase chain reaction (qPCR) assay targeting 39 insertions and/or deletions of chromosomes. MATERIAL AND METHODS The qPCR assay for detecting donor-cell chimerism was performed for 3 post-LT patients with suspected GVHD using KMRtype® and KMRtrack® assays (GenDx, Netherlands). The mean recipient/donor-cell fraction of informative markers unique to each recipient or donor was calculated. RESULTS In Case 1, who received living donor LT (LDLT) from his daughter, initial sign was diarrhea at post-operative day (POD) #23. Case 2 received unrelated deceased donor LT and initial sign was cytopenia at POD #29. Case 3 received LDLT from her son and GVHD associated cytopenia was developed at POD #80. Average PB ddDNA fractions in post-transplant samples of cases 1, 2, and 3 were 39.68%, 78.38%, and 4.76%, respectively. Despite an active treatment including steroid and tumor necrosis factor-alpha inhibitor, 2 patients (cases 1 and 2) died due to multiple organ failures. CONCLUSIONS Early detection of donor-cell chimerism may help halt fatal progression of GVHD-LT. A qPCR test targeting INDEL of chromosomes would be a helpful procedure for timely diagnosis of GVHD.

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用实时荧光定量PCR检测肝移植后疑似移植物抗宿主病受者的供体来源DNA:病例系列和文献综述
肝移植术后移植物抗宿主病(GVHD)是一种罕见但致命的并发症。GVHD的诊断通常基于临床症状和病理证实。然而,由于其非特异性症状,经常被误诊。在这里,我们报告了利用外周血供体来源的脱氧核糖核酸(ddDNA)检测3例疑似GVHD (GVHD-LT)后的供体细胞嵌合,通过实时定量聚合酶链反应(qPCR)检测39个染色体插入和/或缺失。材料和方法采用KMRtype®和KMRtrack®(GenDx,荷兰)检测方法,对3例疑似GVHD的lt后患者进行供体细胞嵌合检测。计算每个受体或供体独特的信息标记的平均受体/供体细胞分数。结果病例1接受了其女儿的活体肝移植(LDLT),术后第23天(POD)的初始体征为腹泻。病例2接受了无亲属关系的已故供者肾移植,初始体征为细胞减少。病例3接受了其子的LDLT,在POD #80时发现GVHD相关的细胞减少。病例1、2、3移植后标本中PB ddDNA的平均含量分别为39.68%、78.38%、4.76%。尽管积极治疗包括类固醇和肿瘤坏死因子- α抑制剂,2例患者(病例1和2)死于多器官衰竭。结论早期发现供体细胞嵌合可能有助于阻止GVHD-LT的致死性进展。针对染色体INDEL的qPCR检测将有助于GVHD的及时诊断。
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来源期刊
CiteScore
2.50
自引率
0.00%
发文量
79
审稿时长
>12 weeks
期刊介绍: Annals of Transplantation is one of the fast-developing journals open to all scientists and fields of transplant medicine and related research. The journal is published quarterly and provides extensive coverage of the most important advances in transplantation. Using an electronic on-line submission and peer review tracking system, Annals of Transplantation is committed to rapid review and publication. The average time to first decision is around 3-4 weeks. Time to publication of accepted manuscripts continues to be shortened, with the Editorial team committed to a goal of 3 months from acceptance to publication. Expert reseachers and clinicians from around the world contribute original Articles, Review Papers, Case Reports and Special Reports in every pertinent specialty, providing a lot of arguments for discussion of exciting developments and controversies in the field.
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